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[Index finger pollicization for congenitally deficient first finger of the hand in children]
F Vázquez Rueda1, J Ayala Montoro, F Blanco López
1Servicio de Cirugía Pediátrica, Unidad de Traumatología y Ortopedia Infantil, Hospital Universitario Reina Sofía Córdoba.
Insights
Index finger pollicization effectively restores thumb function in pediatric patients with congenital first ray deficiency. This surgical technique yields excellent cosmetic and functional outcomes, improving prehension and opposition in young patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Hand Surgery
- Congenital Hand Anomalies
Context:
- Congenital deficiency of the first ray, including absent or nonfunctioning thumbs, presents significant challenges in pediatric hand function.
- Index finger pollicization is a reconstructive surgical technique to address these deficiencies.
Purpose:
- To investigate the outcomes of index finger pollicization for correcting congenital first ray deficiency in pediatric patients.
- To evaluate both the functional and cosmetic results of this procedure.
Summary:
- The study involved 6 index finger pollicizations in 5 pediatric patients (ages 2-8 years) with congenital thumb absence (Blauth type III-V).
- Patients experienced excellent cosmetic and functional results, achieving improved prehension and opposition after an average 8-year follow-up.
- The procedure, performed from age 2 onwards, showed minimal risk of neurovascular complications and did not impede cortical representation of the pollicized digit.
Impact:
- Index finger pollicization is a successful surgical option for improving hand function in children with congenital thumb deficiencies.
- The procedure offers excellent long-term functional and aesthetic results, enhancing quality of life for affected children.
- Early intervention, from age 2, is feasible and beneficial, with careful consideration of potential neurovascular risks.
Abstract:
Pollicization is a single-stage neurovascular pedicle transfer of the index digit to function as a thumb. The objective of this study is to investigate the results of index finger pollicization for correction of congenital deficiency of the first ray in pediatric hand. We have done 6 pollicizations of index fingers in 6 hands (there were 2 right hands, 2 left hands, and 1 bilaterally) in 5 patients (4 boys and 1 girl) who had absent or nonfunctioning thumbs (type III-V of Blauth's classification). Associated anomalies where numerous and included radial club hand, mirror hand and cardiovascular and urologic anomalies. The average time of Kirschner wire extraction was 32 days (30 to 36 days) and to beginning the hand rehabilitation at 5 degrees to 10 degrees day. The average age at pollicization was 5.5 years (range 2 to 8 years), and follow-up averaged 8 years (5 to 11 years). The cosmetic and functional results were excellent, with manual dexterity of prehension and opposition. Pollicization in children can be performed at least 2 years of age, to due of minor risk of neurovascular lesion but without delayed the cortical representation of the pollicized finger.